Neurologist
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Most peripheral neuropathies involve large as well as small-fiber dysfunction. A small subset of neuropathies present with restricted or predominant small-fiber involvement. ⋯ Small-fiber neuropathies are a heterogeneous group of disorders. They vary in etiologies and require special attention, as many disorders are rare and the differential diagnosis is broad. Evaluation is often extensive and may need pathologic specimen. Many patients respond to symptomatic therapy, but some are difficult to treat.
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Patients with large hemispheric strokes frequently develop neurologic deterioration secondary to cerebral edema. Despite supportive care in the intensive care unit and traditional forms of therapy for cerebral edema, they have a high morbidity and mortality. New forms of therapy are being investigated to improve outcome in these patients. ⋯ Neurologic deterioration in patients with large hemispheric strokes necessitates admission to the intensive care unit for management of the airway, blood pressure, and cerebral edema. New promising therapies, such as hemicraniectomy and hypothermia, need to be further evaluated to define their role in the management of these patients.
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Neurosurgical clipping used to be the standard method of occluding intracranial aneurysms, but controlled detachable coils are increasingly used to obliterate aneurysms by endosaccular packing. ⋯ Endovascular treatment of intracranial aneurysms has gained widespread acceptance. Preference for coiling or clipping depends on patient and aneurysm characteristics, and on the local expertise.